You know how sometimes you hear the same thing over and over and then one day it clicks and you just get it? And you wonder why it didn’t click the first 10 times you heard it or even considered it? I’m having that experience right now. Today I read this transcription of a talk given by Ron Rosedale in 2006 for the American Society of Bariatric Physicians (ASBP), entitled “The good, the bad, and the ugly of protein.” Although much of this information is new to me (and a lot of it I’d have to spend more time with to really understand – leptin, MTOR, IGF-1, for example), the theme that too much protein can cause problems is one that has been recurring for me. This passage jumped out at me today:

A high protein intake has endocrine effects such as it increases insulin, increases IGF, and we know these hormones increase the rate of aging. Furthermore the metabolic effect of high urea and many amino acids may exceed the kidney and hepatic system’s ability to metabolize and excrete the excess nitrogen.

In other words, when you use protein as a fuel, you take off the excess nitrogen, and then you have to do something with it. Because, it’s a poison. If you take too much, It causes acidosis in the blood and that causes redistribution of calcium and magnesium, and all sorts of things, and what the consequence are for that is manifold.

So what’s high. Certainly above 1 gram per kilogram of lean mass is probably high. Most people, I’ll put on .7 or .75 grams per kilogram of lean body mass. But if I’ve got a diabetic, and I really want to reverse their aging, which means reverse their diabetes, because diabetes is a model of aging, I’ll put them down to .5 or .6 grams per kilogram of lean body mass per day.

A year ago when I was attempting to eat a ketogenic diet (but failing, cuz too much protein, but I didn’t realize it because I wasn’t bothering to test for ketones) my labs were disappointing. High uric acid, high (bad) lipids, poor BUN/Creatinine ratio, struggling thyroid, high calculated anion gap (which can indicate acidosis). After 4-5 months I was tired and irritable all the time and quit. The above passage explains that maybe some of this was because of my high protein intake, which led to sustained high insulin levels and high nitrogen. Too much protein = high insulin and difficulty eliminating excess nitrogen = metabolic acidosis and feeling shitty.

Rosedale goes on to recommend limiting protein and increasing fat consumption. Starting today I’m using his recommended 0.5 to 0.6 grams of protein per kg of lean body mass. For me that is somewhere in the neighborhood of 60-70g of protein per day. I’ve been eating twice that amount. What do I have to show for it? Overall good energy and sleep, but very slow fat loss and still relatively high hunger. I’ll be using Cronometer to track my intake for a while to make sure I’m staying within that range.

Since my last update I’ve gained back a pound or so. 6 weeks of keto and I’ve lost about 4 pounds and a couple inches from my waist. I’m not complaining….well actually, yes I am complaining. It’s not easy eating a diet this restrictive and exercising 3x a week with so little to show for it. I think the amount of protein I’ve been eating is a critical factor. A possible confounder is that I’ve been eating butter in an otherwise dairy-free diet. I’ll be eliminating that too for now. I can always add it back in later to test for problems.

About 3.5 weeks into a ketogenic diet and I’ve lost 0 pounds or inches. I know what’s going on though, thanks to my handy Kentonix meter, which I got about a week ago. Indeed my problem with low carb in the past (and the present) has been eating too much meat (protein), not enough fat. It’s been extremely hard for me to eat 70%+ of calories from fat because it leaves me hungry. Why is that? Because my insulin is perpetually too high. Becoming fat adapted – burning fat for fuel instead of glucose – is not something that happens overnight. About a week ago I dropped dairy again, since that seemed to work some magic last time around. Since then my hunger has dropped off a little but I’m still nowhere near being able to fast more than 12 hours or so.

A few days ago I got a fasting insulin level to see exactly what it looks like after 3 weeks of no starch or sugar. It was 20.7 (range 2.6-24.9). That’s after 3 weeks of very low carb living. So I added exercise this week – HIIT, specifically – based on the this study and others that indicate quick bursts of intense exercise can help lower insulin. I think by eating 200-300 grams of carbohydrate a day for 4 months from September through December of last year I managed to raise my base insulin level so high that now it’s going to take time and intention to bring it down. I wish I would have tested before starting low carb, but I didn’t.

In any case, I’m sticking with this because I feel so much better throughout the day now and my sleep is so much better. When I eat too much meat the Ketonix lets me know I’m no longer producing ketones…so my diet is a lot of avocados, homemade mayo, spinach and kale for calcium and other nutrients, eggs, coconut oil, and some meat. My hunger is dropping gradually. This will be a slow and steady process.

Last year when I was eating low carb, I was doing it all wrong. I think I was scared of all macronutrients except protein, and instead of following a diet plan that was ketogenic – allowing for the production of ketones to provide fuel to the body – I was following some random Atkins-esque plan. I was losing weight (at first) so it seemed like the right thing to do, but when my weight loss stopped and my labs looked terrible and I started feeling tired and bored with my meat-and-vegetable diet I gave up. I now realize that my focus was misguided. I was targeting carbohydrates (keeping them low) when I should have been targeting insulin.

Thanks to my brilliant commenters I now realize that diet was actually fairly insulinogenic, and with all that insulin it’s impossible to use body fat for fuel. I lost 15-20 pounds eating that way, which probably represented a reduction in my previous Peat-inspired insulin level of 27.9 two years ago. I wonder if this is why people stall on low-carb diets…they manage to reduce their insulin level enough with their meat-and-veggies-only diet, but because the meat is actually insulinogenic the weight stops at the point that the insulin stops dropping. So Atkins had it right up to a point…and for some people that’s enough. Their insulin isn’t so chronically high, or their body isn’t so quick to toss insulin all over the place, and just cutting the carbs is enough to drop insulin low enough that their body can release stored fat for fuel. I’m not one of those people.

For years I’ve had to be very careful of what I eat because everything seems to make me desperately hungry. Coffee, rice, gigantic salads containing many ounces of skinless chicken – always with the ravenous hunger 1-2 hours later. 10 years ago I could eat a “low carb diet” of meat, eggs, and veggies and never feel hungry. Now my blood sugar is much less stable than that, probably because insulin resistance has advanced and therefore insulin output has increased. When I was eating meat/eggs/veggies for 6-8 months last year I would have what seemed like a giant breakfast of steak and eggs – seriously, like 800-1000 calories, and I would be hungry 2 hours later. I figured I was just broken and kept eating more and more to make the hunger go away.

When I originally started with Nourish Balance Thrive I met with their diet specialist, Julie, and she recommended a paleo diet that was 60-65% fat. I think for most people that would probably work well. I eliminated all starch and sugar from my diet and figured I was probably in the ballpark as long as I was eating fatty meats. I really should have Cronometered it, because looking back I was probably getting only about 50% of my calories from fat…and that was not enough. So I was putting myself in a state where I had no carbohydrates for quick energy and no ketones due to high insulin. It’s really no wonder I stayed hungry, weight loss stopped, and I got tired. It seems the goal shouldn’t be low blood sugar – it should be low insulin, as discussed by Dr. Fung in Christopher Kelly’s podcast and Woo all over her blog (though, ironically the latter considers the former to be a menace who must be stopped).

So I’ve been learning over the last couple of days about insulin – how to lower it, how to keep it low, and how to fuel the body while doing that. My goals, of course, are to lose body fat and improve metabolic markers (reduce blood sugar, cholesterol, triglycerides, blood pressure) while not starving and being irritable all the time. I came across the Optimising Nutrition blog discussing an “insulin index” – much more useful to me than a “glycemic index” since my goal is shifting from low blood sugar to low insulin. Contrary to my previous belief, carbohydrate density and insulin demand are not perfectly correlated.

The author states:

“The chart below [see it here] shows the relationship between the glycemic load and insulin index from the testing undertaken in healthy people. Reducing the glycemic load does not guarantee a low insulin response, particularly when it comes to high protein foods.”

Click here and scroll down for a chart of Least Insulinogenic Foods along with their Food Insulin Index. Suddenly my seemingly-random and incredibly-annoying hunger makes so much sense. I was eating too much meat, and my insulin was too high.

So for the last 3-4 days I’ve been following these charts and eating things that are much less insulinogenic. The steps I’ve taken:

Eliminated all dense forms of carbohydrate again (rice, sugar in all forms, etc) limiting carbohydrate intake to just vegetables

The results so far: hunger has dropped about 80% and when it’s there it’s not the gnawing painful type. Irritability and fatigue are gone, unless I accidentally eat too much protein. I learned today that egg yolks (not just the whites) contain a certain amount of protein and 3 of them – even without the whites – is really too much. I’m still working out the details, but Cronometer tells me that even a seemingly high ratio of fat to protein+carb is not high enough to avoid the irritability and hunger that suggest too much insulin was generated. For example, this morning breakfast was 3 egg yolks cooked in coconut oil with half of an avocado. Here’s the macronutrient breakdown of this meal:

So this meal had a ratio of about 2.6/1 fat to carb+protein. About 90 minutes later I had that familiar hunger/irritability. So I’ll be looking for more of a 3/1 or 4/1 ratio which translates to about 75-80% of calories from fat. I ate a couple ounces of macadamia nuts and felt much better.

Further experiments to follow.

I feel really happy. My mood has improved 100% since giving up the carbs again, and it happened on day 1. This is probably related to discontinuing the eating of foods that cause endotoxin. I hope I’m on the right track now.

A side note – taking the Metformin is going well. My hot flashes went away a few days after I started taking it. Things are looking up.

I didn’t get everything tested – just the basics, which is what I could afford right now. Here they are, with the current results in RED.

3/27/2012

11/14/2012

9/6/2013

12/30/2013

Units

Ref

Glucose

98

98

117

114

mg/dL

65-99

Hb A1C

6.4

<7.0

Uric Acid

5.9

5.2

5.4

5.4

mg/dL

2.5-7.1

BUN

19

25

18

18

mg/dL

HIGH

6-24

Creatinine

0.69

0.73

0.57

0.6

mg/dL

.57-1.00

eGFR

108

101

113

111

mg/dL

>59

BUN/Creat Ratio

28

34

32

30

HIGH

9-23

Sodium

138

139

139

138

mmol/L

134-144

Potassium

3.8

3.8

4.5

4.1

mmol/L

3.5-5.2

Chloride

1.3

104

103

104

mmol/L

97-108

Calcium

9.3

9.2

9.4

9.2

mg/dL

8.7-10.2

CO2, Total

28

20

mmol/L

19-28

Phosphorus

3.6

4.1

4.0

3.4

mg/dL

2.5-4.5

Protein, Total

6.8

6.9

7.2

7.1

g/dL

6.0-8.5

Albumin

4.3

4.4

4.4

4.1

g/dL

3.5-5.5

Globulin, Total

2.5

2.5

2.8

3.0

g/dL

1.5-4.5

A/G Ratio

1.7

1.8

1.6

1.4

1.1-2.5

Bilirubin, Total

0.2

0.3

0.3

0.3

mg/dL

0.0-1.2

Alkaline Phosphatase, S

63

64

70

62

IU/L

25-150

LDH

142

137

137

143

IU/L

0-214

AST (SGOT)

20

14

12

15

IU/L

0-40

ALT (SGPT)

25

17

18

20

IU/L

0-32

GGT

14

14

27

20

IU/L

0-60

Iron

66

81

116

88

ug/dL

35-155

WBC

8.7

x10E3/uL

3.4-10.8

RBC

4.36

X10E6/uL

3.77-5.28

LIPIDS

Cholesterol, Total

222

297

270

274

mg/dL

HIGH

100-199

Triglycerides

107

203

288

312

mg/dL

HIGH

0-149

HDL Cholesterol

54

56

43

46

mg/dL

>39

VLDL Cholesterol

41

58

mg/dL

HIGH

5-40

LDL Cholesterol

147

200

169

166

mg/dL

HIGH

0-99

T. Chol/HDL Ratio

4.1

5.3

6.3

6.0

HIGH

0.0-4.4

Estimated CHD Risk (Tot. Chol/HDL)

1.4

1.8

HIGH

0.0-1.0

OTHER

Vitamin D

34.2

67 (on 11/11/13)

ng/mL

32-100

Insulin, Fasting

27.9

uIU/mL

HIGH

2.6-24.9

hs-CRP

8.65

8.12

13.58

mg/L

HIGH

0.00-3.00

THYROID

3/27/2012

11/14/2012

6/19/2013

12/30/2013

Units

Ref.

TSH

1.7

4.01

1.55

2.92

uIU/mL

0.450-4.500

Thyroxine (T4)

4.1

8.9

7.4

6.9

ug/dL

4.5-12.0

T3 Uptake

32

25

27

24

%

24-39

Free Thyroxine Index

2.5

2.2

2.0

1.7

1.2-4.9

T4, Free (Direct)

1.04

0.97

ng/dL

0.82-1.77

Reverse T3

20.9

10.2

ng/dL

9.2-24.1

Triiodothyronine (T3)

126

120

ng/dL

71-180

Thyroid Peroxidase TPO Ab

10

8

IU/mL

0-34

Antithyroglobulin Ab

<20

<20

IU/mL

0-40

Free T3

2.9

2.8

pg/mL

2.0-4.4

The first two columns (3/27/12 and 11/14/12) are when I was eating low carb with about 5% of my diet being carbohydrates for the first, and 10-15% for the second. The third column (9/6/13) I was floundering around, trying on various diets/lifestyles. At that time, about 20% of my diet was carbohydrate. In November I started paying attention to Ray Peat and I increased my carbohydrate consumption to 40-50%, most in the form of simple sugars/fruit. My blood sugars started soaring though, so a few weeks later I switched from simple sugars to starches and cut the quantity down to about 30%, while increasing protein.

So how am I doing?

Blood sugar – fasting glucose is high (but not over 126), HbA1C is not ideal, but is not in the diabetic range, and fasting insulin is high. These factors suggest to me that I am more likely VERY insulin resistant, but not necessarily diabetic yet. The fact that my body is still pumping out that much insulin is a good thing. My pancreas isn’t dead yet. I’m certainly very close to type 2 diabetes, if I’m not there yet…and I know I need to take this very seriously.

Thyroid – I was hoping eating carbs would help thyroid function. However, if TSH is a reliable marker (and Ray Peat says it is) it looks like I did best with some carbs but not many. Of course my triglycerides were happiest with none, but you can’t please everyone.

Lipids – OMG, I’m so about to die of a heart attack. Triglycerides absolutely not going in the right direction…HDL was highest on low carb, LDL a bit better now than it was last winter but still not good. I have been taking very small doses of T3 every day (6mcg), but that clearly isn’t enough to have an impact on cholesterol. Will have to increase it.

And in other news, I’ve decided my gut is completely torn up from 2 rounds of antibiotics this year, and that’s why I’m having trouble tolerating the potato starch. I’ve decided I’m going to mix it with all kinds of junk and make it into BIONIC FIBER. (<– Imagine I said really loud with an echo.) I’m on day 3 of probiotics. I’m going to fix my gut biome, dammit! But most importantly, I have baseline data for my Resistant Starch Experiment.

Every so often I get research fatigue. It’s the head-spinning sensation that comes with reading endless contradictory information about health, diet, exercise, and nutrition. Red meat – high in heme iron (so it’s bad!) but high in carnitine and low PUFA (so it’s good!). Dairy – high in iodine (so it’s bad!), but high calcium to phosphorous ratio (so it’s good!). Fructose – increases triglycerides (so it’s bad!), but increases metabolism (so it’s good!) but causes weight gain (so it’s bad!) but has a lower effect on insulin (so it’s good!). I can’t stand it anymore.

My weight has been up and down a lot – now it’s up. I’m not feeling good anymore. I don’t know if my feelings of well-being associated with eating Peatarian were just a month-long diabetic sugar high or if something positive was actually happening metabolically. I’ve been experimenting with potatoes, trying to find a way to get some carbs in and also keep my blood sugar stable. Eating 1/4 cup of boiled potatoes, along with protein and fat, keeps me from having blood-sugar swings…but also makes me feel dull and lethargic.

Today I listened to Ray Peat’s interview called Glycemia, Starch, and Sugar, in Context. I was driving at the time (for 3 hours, through a blizzard I might add), so I couldn’t take notes, but what I took from it is the following:

Diabetes is caused by Polyunsaturated Fatty Acids (PUFA) in the diet and in the system. Stop eating PUFAs and within a couple days you’ll be more insulin sensitive.

Potatoes have some unique and magical properties, but the magic is in the juice – not in the starch. If you juice a raw potato and drink (or cook with) the juice, there are ketones (or ketone acids?) available that are very healing and can perform miracles like make insomniacs sleep and heal severe digestive problems.

The problem with low-carb diets is the following: The body releases insulin to process the amino acids in proteins. When insulin rises, the body needs to raise blood sugar to avoid hypoglycemia. If there’s no glycogen (sugar) stored in the liver cortisol is released instead, which increases blood sugar. Cortisol suppresses thyroid function and immune function, and lowers metabolism.

Starches can cause bacterial problems in the gut.

Fructose is misunderstood and is awesome.

There was more, of course, but listening from my own insulin-resistant context, this is what I heard.

I haven’t done a great job of getting PUFAs out of my diet. I keep eating chicken. I should stop doing that. It’s worth a try, to see how much of a difference it would make for me to stop that. I’m not even sure why I do. (Edited to add my inner monologue after I hit “Publish”: I know why I do. I really like meat – I like that it keeps me from being hungry. I hate being hungry. And chicken is inexpensive. I can’t even believe how much money we spend on food already. If I upgraded to higher-quality meat I’d have to get a full-time job again. Seriously. Ok, instead, I’ll work on eating less meat, more dairy, more gelatin for protein. /moment of self-awareness)

Hi and Welcome!

I'm Lanie - Middle aged and diagnosed with hypertension, diabetes and general fatness, I'm determined to be healthy again and set a good example for my 7-year old daughter. Please join me in my health-seeking adventures.

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